Disparities in Delivery of Endovascular Therapy: The Florida Puerto Rico Collaboration to Reduce Stroke Disparities Study (CReSD) (S19.003)

Objective: Endovascular thrombectomy improves outcome in select ischemic stroke patients. Background: In the CReSD Registry we sought to determine the clinical, hospital and regional characteristics associated with use of this therapy in stroke patients. Design/Methods: Ischemic stroke patients within 24 hours of onset were prospectively included from 82 sites in Florida and Puerto Rico from January 2010 to April 2016. Multivariable logistic regression with generalized estimating equations evaluated independent predictors of endovascular therapy. Results: Among 58,204 patients (50% male, 65% white, 15% black, 20% Hispanic, mean age ±SD 71±14 yrs), 2111 (3.6%) received endovascular thrombectomy. Endovascular treated patients had a lower risk of vascular risk factors except for Afib (33.7% vs 19.0%), more severe strokes (median NIHSS 15 vs. 5), arrived earlier (median 126 vs. 210 min), via EMS (70.4% vs. 59.6%), during working hours (47.7% vs. 45.6%), to large hospitals (≥ 680 beds) (48.3% vs 28.8%), and treated in South Florida (47.3% vs. 35.9%) as compared to those not treated. In multivariable analysis, older age (OR 0.98, 95% CI 0.98–0.99), Black (OR 0.68, 95% CI 0.56–0.82) vs. White, Medicaid/no insurance (OR 0.71, 95% CI 0.51–0.98), diabetes (OR 0.85, 95% CI 0.77–0.95), previous stroke (OR 0.66, 95% CI 0.55–0.79), off-hour presentation (OR 0.76, 95% CI 0.66–0.88), Northern Florida (North OR 0.40, 95% CI 0.18–0.92 and Panhandle OR 0.12, 95% CI 0.04–0.36 vs. South Florida) remained independently associated with lower use of endovascular therapy. In contrast, early arrival (OR 1.07, 95% CI 1.05–1.08 per minute decrease), to a large hospital (OR 6.67, 95% CI 1.93–23.0), AFib (OR 1.71, 95% CI 1.50–1.95), and prior independent ambulation (OR 1.85, 95% CI 1.02–3.39) were associated with higher use of endovascular treatment. Conclusions: There are significant race, regional and hospital disparities in delivery of endovascular care. Efforts should be made to improve access to endovascular treatment to all eligible patients. Disclosure: Dr. Asdaghi has nothing to disclose. Dr. Granzoti Cintra has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Dong has nothing to disclose. Dr. Ciliberti-Vargas has nothing to disclose. Dr. Gutierrez has nothing to disclose. Dr. Koch has nothing to disclose. Dr. Gardener has nothing to disclose. Dr. Marulanda-Londono has nothing to disclose. Dr. Mueller has nothing to disclose. Dr. Yavagal has received personal compensation for activities with Medtronic and Guidepoint as a consultant. Dr. Mehta has nothing to disclose. Dr. Hanel has nothing to disclose. Dr. Rose has received personal compensation for activities with Boehringer Ingelheim Pharmaceuticals, Inc. Dr. Waddy has nothing to disclose. Dr. Robichaux has nothing to disclose. Dr. Foster has nothing to disclose. Dr. Zevallos has nothing to disclose. Dr. Nobo has nothing to disclose. Dr. Rundek has nothing to disclose. Dr. Sacco has received research support from Boehringer Ingelheim Pharmaceuticals. Dr. Romano has received personal compensation for activities with NovaVision as an advisory board member and consultant.